The effect of a customer-centric approach towards doctors ...

The effect of a customer-centric approach towards doctors in a private hospital

M van der Westhuizen

12877212

Mini-dissertation submitted in partial fulfilment of the requirements for the degree Magister in Business

Administration at the Potchefstroom Campus of the North-West University

Supervisor: Dr WJ Coetzer

May 2014

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ACKNOWLEDGEMENTS

I feel grateful and blessed when looking back on three years in studying towards my

MBA. This of course would never have been possible without the support and

assistance of important persons in my life. My sincerest thank you to all of the below:

Our heavenly Father. He has provided in so many ways. When our son was

diagnosed with eye cancer, He gave me the strength to persevere and reach the

point where I am today. He gave me the courage I needed to conquer all

challenges faced.

My wife for always being there, caring for the children when I had to honour my

commitments and for all your love and support. Thank you for all the

encouragement. You and the children truly bring joy to my life.

My children – Hesmari and Wian, I have drawn the most of my inspiration from you.

You always give me the will to stand up and face another day. Thank you for being

the wonderful children you are. Thank you for all the sincere love any father may

ask for. Hesmari, only three years old, and you are already the big sister a brother

could ask for. Your fighting spirit, witty answers and strong will makes you the

beautiful little girl you are today. Wian, through all the tests and treatments, you

always remained a friendly, smiling little boy – a true inspiration.

My parents, Johann and Merle van Sandwyk, thank you for all the lessons I could

learn from you. Thank you for your invaluable support, love and influence in my life.

You also made this possible.

Natasha Peters and Marna Vosloo, the two biggest friends that I have gained during

my MBA studies. Your support, hard work and cooperation made it possible for me

to reach the stage where we are now.

The PBS management and lecturers. Thank you for sharing your knowledge and

for inspiring me to reach greater heights.

Dr. Wilma Coetzer, thank you for being a great study leader. I really appreciate

your honest feedback, your support, time and effort. Thank you for always listening

and motivating me, beyond the call of a study leader.

Elmari Snoer for proof reading my mini-dissertation and your valuable inputs.

The people in my department at work, you have lightened my burden through your

support and humour. You are the best team any manager can ever ask for.

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ABSTRACT

Key terms: Customer service, product centricity, customer centricity, customer

satisfaction, customer loyalty, private healthcare, doctor relations

Globally, trade and industry has shifted its focus from the traditional service delivery

approaches to various alternative practices to be more successful, cost efficient,

customer orientated, flexible and innovative. This shift in focus has lead to

organisations applying a customer centric approach in their business. In order to

understand customer centricity, it is necessary to be familiar with the term customer

service.

Customer service is the offering of services to customers before, during and after a

purchase. It is a series of activities designed to enhance the level of customer

satisfaction, i.e. the feeling that a product or service has met the customer’s

expectations. Although it seems to be difficult to create and maintain a positive service

culture, the implementation and upkeep of service excellence hold numerous

advantages for organisations in both the short and the long term. Excellent customer

service leads to an increase in profits as well as assist organisations in achieving a

competitive advantage. Organisations with a customer centric approach can expect to

experience a 30% higher return on investment on their marketing efforts compared to

their peers not embracing customer centricity. Moreover, exceptional customer service

will lead to customer satisfaction, which in turn, may well lead to customer loyalty which

is crucial in the current volatile economic market.

Recent economic instability triggered financial uncertainty in trade and industry. This

causes difficulties for organisations to gain a competitive advantage and predict

consumer behaviour. The organisations that will survive and outlive these uncertain

circumstances will be those that maintain a customer centric focus. A customer centric

focus implies that organisations place their customers first by concentrating on their

needs and behaviours. These organisations will also attempt to eliminate internal

factors that constrain service offerings to customers. Furthermore, customer centricity

includes the alignment of resources of the organisation to successfully respond to the

ever-changing needs of the customer, while building mutually profitable relationships.

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The main difference between customer service and customer centricity appears to

relate to meaningful changes that customer centric organisations make in addressing

their customers’ expectations and providing reciprocal support. Customer centricity

seems to take customer service thus a step further with regards to service delivery.

The healthcare environment forms an important part of trade and industry and economic

instability also affects this sphere. In this study, the focus filters to the healthcare

industry in South Africa and the role and importance of a customer centric approach to

doctors. The South African healthcare environment consists of two sectors, namely

large public (managed by government) and smaller, higher quality private healthcare.

The South African healthcare system is unique to those of other countries as it is

dynamic and multifaceted. The legislative framework within the healthcare system

gives South African citizens the right to access healthcare services. Due to a skewed

financing system in healthcare, this framework has a major impact on both the public

and private sectors. The private healthcare industry in South Africa has grown

dramatically with the number of beds doubling between 1988 and 1993. This was

mainly due to the international trends toward privatisation and advanced by

government's policies for privatisation. This resulted in the migration of doctors from

public service to private practices.

Specialists play an integral part in providing healthcare services. The private hospital

industry provides admitting and treating facilities where doctors prescribe the care that

hospitals should deliver to patients. This interplay between private hospitals and

specialists emphasises that specialists are important customers of private hospitals.

The importance of obtaining and retaining doctors is also highlighted in the vision and

mission of the top three private hospital groups in South Africa, namely Mediclinic,

Netcare and Life Healthcare. Many challenges exist to grow and maintain patient

volumes for the private hospital sector. One thereof is to establish doctor (and their

practices') support by building an optimum mix of loyal specialist and general

practitioner (GP) networks for the hospital. The management and nurturing of

relationships with doctors through these networks could lead to a competitive advantage

for private hospitals.

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A study was therefore conducted to gain insight as to how specialists define customer

centricity as well as their expectations of private hospitals when applying a customer

centric approach towards doctors. The research was of qualitative nature. An

experimental research design was applied and included 11 participants. Semi-

structured interviews with specialists from one of the top three private hospital groups

were conducted in order to gather relevant data. The interviews were transcribed and

coded. Results were analysed and interpreted via thorough content analysis.

Participants highlighted the following elements as important when defining customer

centricity: customer focus, satisfaction, facilities and resources, accessibility, safety and

cost effectiveness.

In addition, participants confirmed that the following aspects marked their expectancies

of a customer centric organisation: quality patient care and services, facilities and

resources, effective communication, support and cooperation, provision of sufficient and

well trained staff, mutual financial gains, appreciation, resolving of problems,

involvement in decision making and respect.

Conclusions and recommendations pertaining to future research were also provided.

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TABLE OF CONTENTS

ACKNOWLEDGEMENTS ............................................................................................... i

ABSTRACT .................................................................................................................... ii

LIST OF TABLES ........................................................................................................ vii

LIST OF FIGURES ...................................................................................................... viii

CHAPTER 1: INTRODUCTION AND PROBLEM STATEMENT ................................... 1

1.1 INTRODUCTION ............................................................................................... 1

1.2 PROBLEM STATEMENT ................................................................................... 2

1.3 RESEARCH OBJECTIVES ................................................................................ 4

1.3.1 General Objective .............................................................................................. 5

1.3.2 Specific Objectives ............................................................................................. 5

1.4 RESEARCH METHOD ...................................................................................... 5

1.4.1 Phase one: Literature review ............................................................................. 5

1.4.2 Phase two: Empirical Study ............................................................................... 6

1.4.2.1 Research design..................................................................................................6

1.4.2.2 Participants..........................................................................................................7

1.4.2.3 Ethics...................................................................................................................8

1.4.3 Data Gathering................................................................................................... 8

1.4.3.1 Interviews.............................................................................................................8

1.4.3.2 Research procedures...........................................................................................9

1.4.3.3 Content analyses.................................................................................................9

1.5 LIMITATIONS OR ANTICIPATED PROBLEMS................................................. 9

1.6 CHAPTER DIVISION OF THE MINI-DISSERTATION ..................................... 10

CHAPTER 2: LITERATURE REVIEW ......................................................................... 11

2.1 INTRODUCTION ............................................................................................. 11

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2.2 CUSTOMER SERVICE .................................................................................... 13

2.3 CUSTOMER CENTRICITY .............................................................................. 17

2.4 HEALTHCARE IN THE SOUTH AFRICAN CONTEXT .................................... 20

2.5 DOCTOR RELATIONS .................................................................................... 22

2.6 CHAPTER SUMMARY .................................................................................... 24

CHAPTER 3: EMPIRICAL STUDY .............................................................................. 25

3.1 RESEARCH DESIGN ...................................................................................... 25

3.2 PARTICIPANTS ............................................................................................... 25

3.3 RESEARCH RESULTS ................................................................................... 27

3.4 CHAPTER SUMMARY .................................................................................... 35

CHAPTER 4: CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS ............. 37

4.1 CONCLUSIONS............................................................................................... 37

4.2 LIMITATIONS .................................................................................................. 39

4.3 RECOMMENDATIONS .................................................................................... 40

4.3.1 Recommendations for management members in the private hospital

industry ............................................................................................................ 40

4.3.2 Recommendations for future research ............................................................. 41

REFERENCES ............................................................................................................. 42

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LIST OF TABLES

Table 1.1: Number of admissions for the period 2010 – 2012 ......................................... 7

Table 2.1: A comparison of the product centric and customer centric approaches ........ 12

Table 3.1: Characteristics of the participants ................................................................. 26

Table 3.2: Defining customer centricity .......................................................................... 27

Table 3.3: Medical practitioners’ expectations regarding customer centricity ................ 30

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LIST OF FIGURES

Figure 2.1: The links in the Service-Profit chain............................................................16

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CHAPTER 1: INTRODUCTION AND PROBLEM STATEMENT

1.1 INTRODUCTION

Customer service can be referred to as the offering of services to customers before,

during and after a purchase. It is a series of activities designed to enhance the level of

customer satisfaction, meaning a customer's feeling that a product or service has met

his/her expectation (Boshoff & Gray, 2004:27; Turban, Lee, King, Liang & Turban,

2009:61). The health care industry provides goods and services to doctors and

specialists to enable them to treat their patients with curative, preventive, rehabilitative

and palliative care. When a patient comes to a medical office, facility or hospital, he or

she trusts the facility not only with his or her business but also their health (Boshoff &

Gray, 2004:27).

Hospitals continuously focus on growing and maintaining patient volumes. This is done

by gaining the support of doctors (and their practices) through establishing a network of

loyal specialists and general practitioners (GP’s) that represents and ensures an

optimum mix of disciplines and referrals (Du Plessis, 2011). It is however also

imperative that hospitals, whilst attempting to grow and maintain patient volumes, not

merely focus on keeping patients satisfied, but also clearly define their philosophy on

how care is delivered (Du Plessis, 2011).

For hospitals, specifically private hospitals, to optimise their customer orientation, their

boundaries need to be expanded to incorporate service recipients, i.e. medical

practitioners and patients as temporary members or participants in operational matters

(Bitner, Faranda, Hubbert & Zeithaml, 1997:97). In other words, it is necessary to

recognise that medical practitioners contribute inputs that impact the hospital’s

productivity. A positive impact on productivity will only be possible through both a vast

quantity and high quality of inputs which will result in a valuable output. The perception

that a service is of high quality is always positively associated with the satisfaction and

value that are attributed to a service transaction. A strong customer orientation also

improves the satisfaction and value that are attributed to a service exchange.

Ultimately, a strong customer orientation improves behavioural outcomes (Brady &

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Cronin, 2009:242). Therefore, an organisation benefits from understanding their

customers' perception of value and satisfaction attribution.

The fundamental question as to how a customer orientation such as customer centricity

within the health industry, influences perceived performance from a customer’s

perspective has yet to be addressed. This mini-dissertation is therefore focused on

defining customer centricity as understood by medical practitioners associated with a

private hospital and identifying their expectations with regards to customer centricity.

1.2 PROBLEM STATEMENT

There has been a worldwide shift in focus from the traditional service delivery

approaches to various alternative means, which may be more effective, cost efficient,

customer orientated, flexible and innovative (Fourie & De Jager, 2005:231). It has even

been argued that the quality and level of customer service have decreased as a result

of a lack of support or understanding at the executive and middle management levels

and/or customer service policy (Dall & Bailine, 2004:61). As a result organisations

should make more use of practices that turn good customers into great referring ones,

as failing to do so could lead to a threat to the survival of an organisation (Shoemaker,

2011:50).

Fourie and De Jager (2005:232) and Li (2010) indicated that managers should track and

monitor deficiencies in service delivery in order to determine the priorities in that service

delivery. Providing quality that meets or exceeds customer expectations has become a

major source of competitive advantage for many organisations, as it reduces price

elasticity and builds loyalty and customer retention (Anderson & Fornell, 1994:242).

Service quality has not only been theoretically proven as an important driver of

customer satisfaction but also empirically substantiated in a variety of industries

including service industries such as tourism and health care (Anderson & Sullivan,

1993:136; Boshoff & Gray, 2004:31; Churchill & Suprenant, 1982:498; Heskett, Sasser

& Schlesinger, 1997:76; Woodside, Frey & Daly, 1989:10).

For service providers to remain customer oriented, organisations must strive to

generate, disseminate and be responsive to customer information (Brady & Cronin,

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2009:248). They should display the capacity to learn, that is to identify and adapt to the

needs and wants of consumers. Within the health industry, the initial and long term

impression a hospital has on a doctor, is crucial in the establishment and maintenance

of a long term relationship (Crepeau, 2012:115). By nurturing these relationships, a

hospital can have a competitive advantage. Brady and Cronin (2009:248) indicated that

from the perspective of customers, being customer oriented enhances positive

perceptions on the quality of an organisation’s overall market strategy. In turn, the

positive perception will increase customer loyalty, repurchase and their willingness to

offer positive word-of-mouth recommendations (Brady & Cronin, 2009:248).

A hospital is a “people business” (Li, 2010). Customers within the hospital environment

are not only searching for medical care, but an integrated experience. Li (2010)

indicated that the presence of other service providers residing within the hospital

vicinity, such as laboratories, radiologists, pathologists, cafeteria, specialists, etc.,

contributes to an integrated experience. Coe (2004:1324) also indicated that healthcare

workers are more often than not challenged with high customer service expectations.

Private hospitals therefore have to focus on a well executed service delivery.

According to data available from the Hospital Association of South Africa (HASA1)

(2009), the South African private hospital industry consists of many hospitals with three

distinct hospital groups and smaller independent hospitals. These hospital groups form

a network of hospitals across Southern Africa of which Life Healthcare, Netcare and

Mediclinic have an 80% market share (HASA, 2013). Each group has a different view

on customer services relating to doctors.

Pretorius (2011), Chief Executive Officer of Mediclinic Southern Africa, believes that the

strength of Mediclinic lies in the recruitment and retention of top medical practitioners.

Mediclinic (2013a) are committed to science-based, patient centric healthcare and strive

towards providing word-class acute care. In addition, Mediclinic also focus on the

importance of having medical practitioners in private practice that encompass a wide

range of specialities.

1 The Hospital Association of South Africa (HASA) is a body which link private hospitals with other organisations, including government, the general public, healthcare stakeholders and the media. HASA and its members are committed to provide healthcare services to South Africa (HASA, 2013).

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Life Healthcare (2013a) do not employ the doctors that work within their facilities, but

opined that doctors are attracted to their hospitals, because of modern facilities, new

technology, the quality of care provided by their nursing staff and management's

understanding of the doctors’ needs. Life Healthcare (2013a) further indicated that in

order to support their doctors and maintain a first class environment, they invest money

to replace, upgrade and improve their facilities into new hospitals, wards and theatres.

Also much is spent on technology and equipment to expand services and capabilities.

Lastly, they invest in new developments and business opportunities.

Netcare (2013a), as Life Healthcare (2013a), are of the opinion that they provide

doctors with the best possible setting in which they can work. This setting includes the

provision of quality nursing care, the latest technology, word-class facilities and well-

trained staff. Netcare (2013a) further believe that they support doctors by providing

excellent patient care to all patients. They indicated that they strive to have strong

partnerships with doctors, in order for them to build their organisation and brand.

Netcare (2013a) further indicated an ongoing improvement of their facilities as doctors

have the opportunity to comment on all aspects of their relationship with the

organisation.

Gunning (2009:57) indicated that “A customer centric organisation focuses primarily on

the needs and behaviours of its customers, rather than internal drivers or internal

constraints that can unnecessarily limit customer offerings”. Wagner and Majchrzak

(2007:19) indicated that only the customer self can articulate these needs. The

perceived customer centric relationship between medical facilities and specific private

hospitals and the medical practitioner is an area that still needs to be more explored

within the South African context. The question can be raised whether the hospital's

view regarding customer services align with that of the medical practitioner. A stronger

focus on medical practitioners as customers of hospitals are therefore needed.

1.3 RESEARCH OBJECTIVES

The research objectives are divided into general and specific objectives.

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1.3.1 General Objective

The general objective of this research was to determine medical practitioners’,

associated with a private hospital, understanding and expectations of customer

centricity.

1.3.2 Specific Objectives

The specific objectives of this research were:

To determine how customer centricity is conceptualised in literature;

To determine the similarities and differences between customer service and

customer centricity, as described in literature;

To determine how customer centricity is defined by medical practitioners associated

with a private hospital;

To determine the expectations of medical practitioners, associated with a private

hospital, in terms of customer centricity from the hospital; and

To make recommendations for future research.

1.4 RESEARCH METHOD

This research, pertaining to the specific objectives, consists of two phases, namely a

literature review and an empirical study.

1.4.1 Phase one: Literature review

Phase one provides a review of the literature pertaining to the specific topic. Books

(see reference list), academic journals and Internet sources were consulted to give a

theoretical exposition of and to prepare for this presentation (study). Literature was

derived from:

• Academic Search Premier

• Emerald

• EBSCO host

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• Internet

• Google Scholar

• NWU (North-West University) Institutional Repository

• Company specific documentation of various private hospitals

1.4.2 Phase two: Empirical Study

The empirical study includes the research design, participants, ethics, data gathering,

research procedures and data analysis.

1.4.2.1 Research Design

The purpose of the research design was to ensure that all criteria of a scientific study

were met.

A qualitative approach was applied in the research design as it best serves the

objectives of this study. Welman, Kruger and Mitchell (2005:188) describe qualitative

research as a descriptive form and noted that qualitative research is ideal in the

description of groups, communities and organisations. As insight is sought into medical

practitioners' expectations of a private hospital from a customer centric viewpoint,

description of their feelings and opinions were necessary. Therefore, the qualitative

approach best suits the study. Furthermore, qualitative research presents the

researcher the opportunity to truly understand the in-depth feelings and motivations of

participants (McDaniel & Gates, 2005:109; Nuttall, Shankar, Beverland & Hooper,

2011:153). Thus, this approach enabled the researched to deeper explore each

participant’s point of view as the semi-structured interview was applied to gather

information. This qualitative method gave scope for explorative questions from the

researched and initially presented participants with open ended questions. Qualitative

research further allows for theoretical insights to be tested and expose theoretical

constraints (Bansal & Corley, 2012:513).

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1.4.2.2 Participants

Considering the sample of participants, the challenge was to determine if general

practitioners should be included in the sample or if the sample should only constitute

specialists. Although some general practitioners (GP’s) actively utilise the facilities

provided by private hospitals, most GP’s in larger towns or cities refer patients to

specialists for treatment within a hospital environment. For this reason, this study

included only specialists in the sample.

The following data, pertaining to general practitioner and specialist activity, was drawn

from a data warehouse of a private hospital (Source omitted for confidentiality

purposes).

Table 1.1: Number of admissions for the period 2010 – 2012

2010 2011 2012 Total

Specialists 8556 8894 9026 26476

General practitioners 864 714 582 2160

A purposive sample of specialists, within various specialities was used in this study.

Due to the specialist activity, the researcher envisaged to continue interviews with

specialists until a saturation point was reached. A total of eleven interviews were

conducted.

The study population consisted mainly of white (100%) male (81.8%) participants

between the ages of 31 to 40 years (45.4%) and 51 to 60 years (54.6%). The average

years in practice in total were 21.4 years and 15.3 years within a private hospital.

Specialities included Ophthalmic surgery (1 participant), Gynaecology (2 participants),

General surgery (2 participants), Paediatrics (2 participants), Anaesthesiology (2

participants), Orthopaedic surgery (1 participant) and Internal medicine (1 participant).

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1.4.2.3 Ethics

The consent of the participants was deemed a very important prerequisite for the

conduction of the research study. Only participants that took part out of free will were

interviewed.

Information gained from the research was dealt with anonymously and confidentially.

Data originally collected from the research was not altered.

The sample was unbiased in terms of age, occupation, race, sex and level of the

participants. The focus was on ascertaining a holistic view of specialists with regards to

their needs and feelings related to the service they receive from private hospitals.

1.4.3 Data Gathering

1.4.3.1 Interviews

Interviews allow the researcher the opportunity to achieve knowledge from participants

(Doody & Noonan, 2013:31). Semi-structured interviews were conducted with

specialists. These interviews were recorded on tape. The participants had the

opportunity to withdraw from the interview at any stage. Welman et al. (2005:166)

indicated that semi-structured interviews are slotted between the two extremities of

unstructured and structured interviews.

The responses of the interviewees determined the flow and direction of the interviews.

The interview was opened with two main questions, after which the interviewees were

probed on the answers given. Probing was used to gather more information and clarity

on the participant's point of view. This brought about that questions varied from one

interview to another. As the semi-structured interview allows the researcher and

participants more flexibility to explain complex or personal topics, participants were

allowed to explain open ended and close ended questions through questions like:

“Please explain what you mean by...” and “Why do you think...” (De Vos, Strydom,

Fouché & Delport, 2005:296; Doody & Noonan, 2013:30; McDaniel & Gates, 2005:133).

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1.4.3.2 Research procedures

All specialists were contacted telephonically to arrange the interviews at their respective

consulting rooms (this was the most comfortable for the participants and interruptions

were minimal). When they were contacted the purpose of the study was explained and

their willingness to participate in the study was determined. The interviews were

conducted by the researcher himself.

The time for completion of each interview ranged from 32 to 58 minutes. All interviews

were recorded on tape and field notes were taken. After the interviews were conducted,

the recordings were transcribed. These transcripts were then interpreted by way of

thorough content analyses.

1.4.3.3 Content analyses

Data that is relevant and accurate forms the basis of quality research (Watkins,

2006:108).

The recordings of interviews were transcribed and the field notes processed, which

allowed for the analysis of raw data. As the identification of themes is one of the most

crucial tasks when conducting qualitative research, themes were identified and

extracted during and after conducting the interviews. (Welman et al., 2005:211).

Thus, themes were drawn from the data collected. The data was coded. This allowed

the researcher to convert word to numbers and symbols, leading to a less complicated

data analysis (Welman et al., 2005:213).

Subsequently, a report on the identified themes was written.

1.5 LIMITATIONS OR ANTICIPATED PROBLEMS

Some of the medical practitioners that were contacted had busy schedules, thus finding

an appropriate time for interviews was troublesome. The income of medical

practitioners is dependent on the amount of time they allocate to patients. Thus an

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interview ranging from 32 to 58 minutes had a rather great cost implication for the

participants.

1.6 CHAPTER DIVISION OF THE MINI-DISSERTATION

The chapters in this mini-dissertation are presented as follows:

Chapter 1: Introduction and problem statement.

Chapter 2: Literature Review.

Chapter 3: Empirical study.

Chapter 4: Conclusions, limitations and recommendations.

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CHAPTER 2: LITERATURE REVIEW

2.1 INTRODUCTION

Uncertainty in volatile economies has made the gaining of a competitive advantage and

prediction in consumer behaviour near to impossible. The organisations that will survive

and outlive these uncertain circumstances will be those that maintain a customer centric

focus. This in turn implies that organisations should know the risks and opportunities

that form part of their customer base (Tyrer, 2009:11). It also includes setting customer

goals, integrating customers within the corporate strategy and implementing customer

oriented activities (Burman, Meurer & Kanitz, 2011:50).

Customer centricity does not make the organisation a “doormat” for customers, but

organisations that do not succeed in maintaining profitable relationships with customers,

may find their existence at risk (Bailey & Jensen, 2006:3; Gummesson, 2008a:316).

Customer centricity contains the full integration of the customer within all internal

processes, shifting the view of customers to that of being the major stakeholder in

organisations (Burman, et al., 2011:50).

Shah, Rust, Parasuraman, Staelin and Day (2006:122) indicated that organisations of

the 21st Century, should embrace customer centricity as a tool to survive in the

marketplace. Thus, organisations should focus on the need of customers to be treated

as partners within a trusted relationship. Accomplishing this, will provide organisations

with the opportunity to distinguish themselves by having a loyal customer base. This

will also provide more stability to the organisation in uncertain times. Successfully

managing customer centricity will enable organisations to compete more intensely, act

with more confidence, respond to changing market conditions and reap financial

benefits (Shah et al., 2006:122; Sohail, 2003:197; Tyrer, 2009:12).

The commitment of many organisations towards their customers is reflected in annual

reports. The focus however, remains product centred, with customer focus merely

acting as a window dressing tactic. Shah et al. (2006:114) have distinguished between

organisations that are product centred and organisations that are customer centred

(refer to Table 2.1).

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Table 2.1: A comparison of the product centric and customer centric approaches

(Shah et al., 2006:115)

Product centric approach Customer centric approach

Basic philosophy

The sale of products,

irrespective of who the

customers may be.

The serving of customers, the

opportunity for advantage and

the customer are the starting

points.

Organisation orientation Based on transactions Based on relationships

Product positioning

Product features and

advantages are highlighted.

The way in which a specific

product meets the needs of a

customer is highlighted.

Organisational structure

Internally focused on

operations, e.g. new products,

market growth, obtaining new

accounts etc. Customer

services are left to the

marketing department.

Externally focused on the

customer, e.g. development of

customer relations, profitability

is obtained from customer

loyalty, employees are the

advocates of customers.

Performance metrics

New product outputs, market

share, product profitability.

Value to customers, customer

retention, satisfaction of

customers.

Management criteria Product portfolio Customer portfolio

Selling approach The number of customers the

products can be sold to.

The number of products that

can be sold to a customer.

Customer knowledge Customer data are used as a

control mechanism.

Knowledge of customer is

deemed an asset.

Organisations that focus on customer centricity, place their customers first by focusing

on their needs and behaviours. These organisations will also attempt to eliminate those

internal factors that constrain service offerings to customers (Gunning, 2009:57).

In the South African context, the three largest hospital groups implicitly express their

commitment to a customer centric approach through their vision and mission

statements. Life Healthcare (2013b) envisages its organisation “...as a world class

provider of quality healthcare for all”. In their culture statement they indicate that they

will achieve the vision through close collaboration with doctors. This will provide doctors

with the opportunity to deliver high quality and excellent clinical services to patients and

their families. Mediclinic (2013b) strives to “...be regarded as the most respected and

trusted provider of hospital services by patients, doctors and funders of healthcare”.

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Netcare (2013b) has the following, more comprehensive vision statement: “Develop and

implement successful solutions to provide quality, affordable healthcare to the people of

South Africa and globally by inspiring our people, creating new healthcare horizons and

delivering value to all stakeholders; be a leading corporate citizen, proud of our heritage

and what we give to society; strive for excellence in a unique brand of patient care

delivered by people who are passionate about the sanctity of life, personal respect and

dignity; and invest in people, infrastructure and technology and establish lasting

partnerships with healthcare professionals”.

From the various statements, patients are perceived as the primary customer of private

hospitals. However, doctors have a direct impact on the income stream of private

hospitals and are therefore regarded as equally important customers (Kohli, Piontek,

Ellington, Van Osdol, Shepard & Brazel, 2001:173). The current research is focused on

the health practitioner, and specifically specialists as customer and their perception

towards customer centricity. To fully comprehend how private hospitals, such as

indicated, will be able to achieve their set vision statement, it is important to understand

customer services and the difference or similarity with customer centricity.

2.2 CUSTOMER SERVICE

Customer service is the provision of services to customers before, during and after a

purchase. It is a series of activities designed to enhance the level of customer

satisfaction, i.e. the feeling that a product or service has met the customer’s

expectations (Boshoff & Gray, 2004:27; Turban, Lee, King, Liang & Turban, 2009:61).

Investopedia (2013:1) defines customer service as “the process of ensuring customer

satisfaction with a product or service. Often, customer service takes place while

performing a transaction for the customer, such as making a sale or returning an item.

Customer service can take the form of an in-person interaction, a phone call, self-

service systems, or by other means”.

Research indicated that there is scepticism towards customer service initiatives and that

the achievement of excellence and the sustaining of gains from such initiatives are

difficult to achieve (Carrick, 2010:55; Scott, 2013:64). The scepticism seems to result

from failures in the past, where some of the customer service efforts were only focused

14

on front-line training, which was perceived as “charm school” or “band aid” efforts.

Support from top management was lacking and in some cases non-compliance resulted

in little to no consequences. Individuals did not accept accountability and some

managers were not equipped with the necessary tools or infrastructure to improve

service delivery within their functional areas (Scott, 2013:64). It has even been argued

that the quality and level of customer service have decreased because of a lack of

support or understanding at the executive and middle management levels and/or

customer service policy (Dall & Bailine, 2004:61).

It seems complicated to create and maintain a positive service culture, but the

implementation and upkeep of service excellence hold numerous advantages for

organisations in the short and the long term (Scott, 2013:67). Not only does excellent

customer service lead to an increase in profits, but it also assists organisations in

achieving a competitive advantage (Band, 1988:16; Boshoff & Gray, 2004:27; Carrick,

2010:55; Heskett, Jones, Loveman, Sasser & Schlesinger, 1994:164; Price, 2012:16).

Bourne (2012:64) makes this even more evident by noting that although the effect of

quality and price on customer behaviour is important, the biggest differentiating factor is

friendly, excellent and efficient customer service. Heskett et al. (1994:164) also

indicated that when customers are satisfied with the services received that their loyalty

towards the organisation will increase. There appears to be a direct link between

customer loyalty and customer satisfaction (Homburg & Giering, 2001:43).

For organisations to benefit from the competitive advantage gained from excellent

customer service, they need to firstly understand customer service from the customer’s

point of view. This will enable the organisation to deliver effective customer service that

stands out in a customer’s mind, which will distinguish the organisation when compared

to poor customer service delivered by many organisations (Price, 2012:17).

In order to have a spirit for service in an organisation, a system for service is needed.

This is even more evident within the private healthcare industry where doctors prescribe

the care to patients and hospitals deliver the care as prescribed. According to Scott

(2013:64-65) a service culture in healthcare organisations can be created if leaders

within the industry pay attention to the following:

15

Raise awareness of customer service and create the correct mindset towards it

within the organisation;

Set service expectations and standards of behaviour. These standards of

behaviour should be set and reinforced, and should not merely be a “wish list”.

Price (2012:18) indicated that the mission statement of an organisation should be

aligned with clear, concise, observable, measurable and realistic service

expectations. Employees should also understand that compliance to service

expectations will be measured on a regular basis;

Identify and eliminate barriers and obstacles, including policies, procedures, norms

and protocols that inhibit the delivery of satisfying customer care;

Listen to customers through measurement and feedback techniques, which provide

valuable data to rectify non-compliance with set service expectations. This can

serve as a basis to empower and train staff and create a platform where set service

expectations can be reviewed and adapted. Band (1988:16) noted that

management should ensure that platforms for feedback are created for customers

and that staff members should be rewarded for complying with set expectations;

Learn and develop skills of staff members at all levels, by making use of all learning

opportunities to engage staff in this process and ultimately making them responsible

for the delivery of good customer services. It is also important to equip leaders with

the necessary tools to lead their teams to service excellence. This is as important

as financial growth and viability. Continuous improvement should be reinforced and

supported, as it is difficult to keep energy, learning initiatives, improvement and

commitment alive. Management should also reflect service excellence at all times,

as this may lead to an increase in staff members reflecting the same type of

behaviour. Price (2012:16) agrees with this statement and is of the opinion that

customer service is a leadership matter. It is therefore important for leaders to

model and reward good customer service.

Heskett et al. (1994:165) indicated that customer service requires a special type of

leadership, where leaders of an organisation place emphasis on the importance of

employees and customers. In their research they developed a service-profit chain

though the analyses of successful service organisations. Within this service-profit chain

relationships between profitability, customer loyalty, and employee satisfaction, loyalty

16

and productivity were established. Heskett et al. (1994:165) indicated that the specific

linkages in the service-profit chain are (See Figure 2.1):

Customer loyalty drives profitability and growth;

Customer satisfaction drives customer loyalty;

Value drives customer satisfaction;

Employee productivity drives value;

Employee loyalty drives productivity;

Employee satisfaction drives loyalty;

Internal quality drives employee satisfaction; and

Leadership underlies the chain’s success.

Figure 2.1: The links in the service-profit chain (Heskett et al., 1994:166)

Homburg and Giering (2000:57) acknowledge and support the research and model of

Heskett et al. (1994), but are of the opinion that previous research has neglected the

moderator effects on the relationship between satisfaction and loyalty. Other important

moderators in the satisfaction-loyalty link seem to be age and income of the customer.

Shah et al. (2006:113) noted that: “it is the customer who determines what a business

is, what it produces, and whether it will prosper”. The role of the customer, inclusive of

age, income, gender and other demographic elements, plays a vital role in

organisations when defining customer service and service expectations.

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2.3 CUSTOMER CENTRICITY

Shah et al. (2006:113) indicated that customer centricity is not a modern term, but noted

that it has only been in recent years that organisations have truly embraced this

concept. A simplistic definition of customer centricity is placing the customer at the

centre of a company’s marketing effort, focusing on customers rather than sales

(Dictionary.com, 2013). It is a specific approach in doing business that focus on the

customer (Investopedia, 2013). Organisations focused on customer centricity ensure

that the customer is at the centre of the organisation’s philosophy, operations or ideas

and they operate from the belief that their customers are the only reason they exist.

These organisations will use every mean possible to keep the customer happy and

satisfied (Investopedia, 2013).

JL Watson Consulting (2012) indicated that a customer centric focus, in its simplest and

most pure sense, means making the customer's life easy. It involves designing

processes that are focused on delivering a positive experience to the customer, making

it extremely easy for the customer to learn about the organisation, do business with the

organisation and get support from the organisation when it is needed. Customer

centricity is the alignment of an organisation's resources to effectively respond to the

ever-changing needs of the customer, while building mutually profitable relationships

(Bailey & Jensen, 2006:3).

In order for organisations to sustain performance in uncertain market conditions,

organisations need to be conscious that customer profiles are becoming more diverse

with ever changing needs whilst customer loyalty is also on the decrease (Tyrer,

2009:11). With the change in the complexity of customer expectations it is becoming

more difficult and challenging for organisations to fulfil the expectations of the customer

and still make a profit (Millstein, 2007:2A; Tyrer, 2009:11). Adding to the challenge,

Shah et al. (2006:114) indicated that executives continuously add pressure on

marketing departments to realise increased productivity, competition in the majority of

industries are increasing, customers and consumers are becoming more informed and

demanding, and technology is advancing.

Organisations therefore have to truly understand who their customer is and what their

needs are. Information of customers should be gathered by means of customer

18

surveys, interviews with customers and observation of customers’ behaviour, where

customer involvement plays a vital role (Bailey & Jensen, 2006:6). Organisations,

having this knowledge, can provide the right service to the customer at the right time

and place (Womack & Daniel, 2005:61). Gummesson (2008a:323) concur with the

above and opined that organisations and people are brought together through the

establishment and maintenance of relationships. Organisations should therefore

interact with customers in these relationships and not merely manage the relationship

with the customer. A balanced centricity should therefore be achieved with mutually

beneficial relationships with all stakeholders inclusive of customers.

Shah et al. (2006:113) noted that organisations which are truly customer centric can

experience a 30% higher return on investment (ROI) on marketing efforts than their

peers not embracing customer centricity. Customer centricity is becoming imperative

for the gaining of a competitive advantage in a crowded marketplace (Evans, 2008:22).

Taking a holistic view of the organisation and all stakeholders will result in the provision

of quality services to the end customer in line with their needs. Gummesson (2008b:16)

indicated that improvement even in other operational areas such as production within an

organisation may lead to improved customer service. Not denying the need for proper

customer relationship management, Tyrer (2009:13) indicated that organisations seem

to shift their focus more to customer experience management. This implies utilising the

knowledge gained of the customer through customer analysis and segmentation to

reach the right customer at the right time by means of effective channels whilst

remaining focused on the solution and forming effective partnerships. Through

customer segmentation and predictive analyses, organisations can identify market

opportunities, risks in competition, invest in accurate business and market intelligence

and have knowledge of the exact factors that influence the buy behaviour of customers

(Tyrer, 2009:13).

Burman, et al. (2011:50) indicated that customer programmes are generally set under

the notion of customer relationship management and that they tend to usually focus on

the technical aspects. They further opined that customer relationship management

does not incorporate the actual needs and expectations of customers and the way in

which these needs and expectations should be addressed. Customer centricity

19

therefore closes the evolving gap through a systematic approach of managing customer

needs (Shah, et al., 2006:122).

Organisations that are customer centred realise and acknowledge the value that their

customers add to their specific organisation (Jacobson, 2002:20). These organisations

will also stay close to their customers in uncertain times and will constantly ascertain the

needs of their customers and their performance against expectancies. Customer

centric organisations provide customer experiences that are relevant. These

experiences should be designed in such a way that the organisation places itself in the

position to capitalise on opportunities, which will ensure profitable growth. These

opportunities should be tailored to the preferences of targeted customers or customer

segments (Tyrer, 2009:15).

Whilst customer centric organisations explore ways to satisfy the needs of their

customers with delivering greater value, making it easier and a more delightful

experience, customer focused organisations only fulfil customer needs in so far as they

are self-serving and address the organisation’s imperatives (Finkelstein, 2013). The

main difference between customer service and customer centricity appears to relate to

meaningful changes that customer centric organisations make in addressing their

customers’ expectations and providing reciprocal support. Customer centricity seems to

take customer service thus a step further with regards to service delivery.

In order to assist hospitals in providing a customer orientation that is in line with the

expectations of the consumers, i.e. medical practitioners as per this research, and that

also embraces the principles of customer centricity, a strong focus on medical

practitioners as customers of a hospital is needed. In other words, recognising that

customers, and specifically medical practitioners, contribute inputs to the hospital, much

like employees, which impact the hospital’s productivity both via the quantity and quality

of those inputs and the resulting quality of output generated (Bitner et al. 1997:97).

However, to understand how hospitals, specifically within the private sector, need to

review and adjust their customer orientation, it is imperative to understand the

healthcare industry within the South African context.

20

2.4 HEALTHCARE IN THE SOUTH AFRICAN CONTEXT

The South African healthcare environment consists of two sectors, namely large public

(managed by government) and smaller, higher quality private healthcare. Individuals

and entities that form part of the South African healthcare system are healthcare

providers (which include doctors, pharmacists and allied professionals, such as

physiotherapists and dieticians), pharmaceutical companies, hospitals, health insurers

and healthcare suppliers (Boshoff & Gray, 2004:27; Centre for Development and

Enterprise (CDE2), 2011:38; Expatica, 2012; Medpages, 2013). “The South African

health care system is the sum of all the organisations, institutions, resources, people

and actions whose primary intent is to promote, restore and maintain health”

(Department of Higher Education and Training (DHET), 2013:1).

The South African healthcare system is unique to those of other countries. It is dynamic

and multifaceted. The legislative framework within the healthcare system gives South

African citizens the right to access healthcare services. This framework has a major

impact on both the public and private sectors, due to a skewed financing system in

healthcare (Department of Health (DOH), 2013; DHET, 2013:1).

Coovadia, Jewkes, Barron, Sanders and McIntyre (2009:826) estimate that only 15% of

the South African population make use of private medical schemes for the funding of

healthcare services provided by the private sector. However, 46% of total healthcare

expenditure is offered by these medical schemes. Another 21% of the population make

use of the private sector by means of private payments, although they mainly make use

of the public sector for the provision of healthcare services. The remainder of the

population (64%) make solely use of public health services that are made available to

them. Private hospitals and specialists constitute for 56% of medical aid expenditure

(Coovadia et al., 2009:826). Kohli et al. (2001:173) indicated that patients rely on

doctors to determine the hospital in which they will be treated.

2 CDE is an advocacy agency which conducts research on policies. The focus of CDE is on how critical development issues impact democratic consolidation and economic growth. Policy recommendations are made on the basis of research in international as well as South African contexts. Economic and social issues are addressed in these recommendations (CDE, 2013).

21

The current Ministry of Health is known for relatively fair policy making. However, the

execution, monitoring and evaluation of these policies are not receiving the attention it

should (CDE, 2011:32; Coovadia et al., 2009:831). The variability in the quality of

healthcare provision of the public sector highlights less than adequate productivity,

leadership, management and stewardship within this sector. Well managed public

hospitals obtain better financial and clinical results, with the contrary also being true

(CDE, 2011:32; Coovadia et al., 2009:831). The management of private healthcare

organisations distinguish them from the public organisations because of their knowledge

and experience in the provision of high quality and cost effective healthcare services

(CDE, 2011:33). Thus, the majority of South African citizens currently do not have

access to high quality healthcare services (DOH, 2013). General practitioners and

specialists concur with this view in a recent study conducted by Medical Chronicle (a

medical publication) and Lifechoice, which is an advisory company (Good, 2012). A

mere 12.4% of the respondents expressed optimism towards the future of South African

healthcare (Good, 2012). Furthermore, the Department of Health itself, confessed to

the public that South African healthcare outcomes are sub-standard when compared to

peer countries, as indicated by increased infant and maternal mortalities (CDE,

2011:32).

Mediclinic, Netcare and Life Healthcare are members of The Hospital Association of

South Africa (HASA) and together with National Health Network (NHN) facilities

constitute for 80% of the South African private hospital industry, with a contribution of

R110 billion to the economy of South Africa in 2010, resulting in an increase in

competition for the attraction of patients (Boshoff & Gray, 2004:28; HASA, 2013).

Econex (2012:3) highlighted the economic importance of the private HASA member

hospitals. These hospitals contribute to the Gross Domestic Product (GDP) and

employment of South Africa and provide significant labour income and tax revenue.

The private healthcare industry in South Africa has grown dramatically, with the number

of beds doubling between 1988 and 1993. This was mainly due to the international

trends toward privatisation and further advanced by the government's policies of

privatisation. This resulted in the migration of doctors from public service to private

practices (Coovadia et al., 2009:826). During the 1990’s, 62% of general practitioners

and 66% of specialists settled their practices within private hospitals. This resulted in

22

admitting their patients to these hospitals. In 2011, it was estimated that the amount of

medical practitioners in private practice increased to 76.2% (Strachan, Zabow & Van

der Spuy, 2011:524).

Doctors have increasing options regarding healthcare facilities in both the public and

private sector, which they can utilise. Hospitals, both in the public and private sector,

have to initiate and maintain relationships with doctors with specific focus on those

factors that increase the doctors' satisfaction (Kohli et al., 2001:173) for long term

sustainability and return on investment. Healthcare facilities therefore have to ensure

that their customer orientation to medical practitioners and their patients are aligned

with the expectations of and the quality services required from medical practitioners.

2.5 DOCTOR RELATIONS

Healthcare providers attempt to align with doctors for various strategic reasons, such as

increase in revenue, enhancement of quality healthcare services, cost control and

effective managed care3.However, research indicated that the majority of these attempts

have failed in the past (Burns, Alexander, Shortell, Zuckerman, Budetti, Gillies &

Waters, 2001:10).

Research has indicated a general worldwide decline in the morale of doctors, although

the reasons for this are not generally known (Edwards, Kornacki & Silversin, 2002:835).

Accountability is on the increase and independence on the decrease. Doctors feel that

regulations, policies and protocols by government and healthcare managers, place

boundaries around their professional lives. The benefits of these regulations are

recognised, however it has a direct impact on the satisfaction of doctors (Edwards et al.,

2002:836). Practicing medicine is an emotionally draining and complicated profession.

This attributed with a self critical personality trait, has increased work stress amongst

doctors (Edwards et al., 2002:836).

3 Definition of managed care: “Any arrangement for health care in which an organisation, such as an HMO, another type of doctor-hospital network, or an insurance company, acts as intermediate between the person seeking care and the physician.” (Medical Dictionary, 2013)

23

Doctors should be equipped with the resources to effectively perform their duties. A

participative approach towards doctors, in the setting of goals and improvement of

clinical outcomes are necessary to improve their morale. Mutual support and respect

are pre-requisites for ensuring a successful relationship between doctors and

healthcare providers (Edwards et al., 2002:837).

Pretorius (2011), Chief Executive Officer of Mediclinic Southern Africa, believes that the

strength of Mediclinic remains in the recruitment and retention of top medical

practitioners. Mediclinic (2013a) are committed to science-based patient centric

healthcare and strive towards providing word-class acute care, but is also focused on

the importance of having medical practitioners in private practice that encompass a

wide range of specialities.

Life Healthcare (2013a) does not employ the doctors that work within its facilities but

opined that doctors are attracted to their hospitals, because of modern facilities, new

technology, quality care provided by their nursing staff and management's

understanding of the doctors’ needs. Life Healthcare (2013a) further indicated that in

order to support their doctors and maintain a first class environment, they invest money

to replace, upgrade and improve their facilities; invest in new hospitals, wards and

theatres, technology and equipment; expand services and capabilities; and invest in

new developments and business opportunities.

Netcare (2013a), as Life Healthcare (2013a), is of the opinion that it provide doctors

with the best possible setting in which they can work as they provide quality nursing

care, the latest technology, word-class facilities and well-trained staff. Netcare (2013a)

further believe that they support doctors by providing excellent patient care to all

patients. They indicated that they strive to have strong partnerships with doctors to

build their organisation and brand. Netcare (2013a) further specified that the

opportunity given to doctors to comment on all aspects of their relationship with the

group, has lead to an ongoing improvement at their facilities.

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2.6 CHAPTER SUMMARY

Customer centricity is placing the customer at the centre of a company’s marketing

effort (Dictionary.com, 2013). It is a specific approach in doing business that focus on

the customer (Investopedia, 2013). Where customer focused organisations mainly fulfil

customer needs in so far as they are self-serving and address the organisation’s

imperatives, customer centricity is aimed at exploring various ways to satisfy the needs

of customers with greater value deliverance and a more delightful experience

(Finkelstein, 2013).

Within the private healthcare industry, the challenge remains to create and maintain a

positive service culture that continuously embraces an ever changing customer profile.

The implementation and upkeep of service excellence hold numerous advantages for

this industry in both the short and the long term (Scott, 2013:67). Shah et al. (2006:122)

indicated that in general organisations of the 21st Century should embrace customer

centricity as a tool to survive in the marketplace. Thus, private hospitals should also

focus on the need of their customers (the practicing specialists as the focus of this

study) to be treated as partners within a trusted relationship. Accomplishing this, will

provide the private hospitals with the opportunity to distinguish themselves with loyal

specialists and will also provide more stability to them as a business in uncertain times.

The successful management of customer centricity will enable the private hospital to

compete more intensely, act with more confidence, respond to changing market

conditions and reap financial benefits (Shah et al., 2006:122; Sohail, 2003:197; Tyrer,

2009:12). It is evident from the literature that modern organisations should embrace

customer centricity as a contrivance for survival, growth, realising and increasing profits

and the gaining of a competitive advantage.

Within this chapter a distinction was made between customer service and customer

centricity, an overview was given of the health sector within South Africa and doctor’s

relations within private hospitals. Chapter 3 follows with details and explanation of the

empirical study.

25

CHAPTER 3: EMPIRICAL STUDY

In this chapter the results of the empirical research is reported and discussed in terms

of the qualitative results. The results are presented based on the proposed research

questions as indicated in Chapter 1.

3.1 RESEARCH DESIGN

For the purpose of the objectives of this study, a qualitative approach in the form of

interviews was used. Welman, et al. (2005:188) describe qualitative research as a

descriptive form and is ideal in the description of groups, communities and

organisations. Qualitative research allows the researcher the opportunity to truly

understand the in-depth feelings and motivations of participants (McDaniel & Gates,

2005:109; Nuttall, et al., 2011:153). Qualitative research allows for theoretical insights

to be tested and expose theoretical constraints (Bansal & Corley, 2012:513).

3.2 PARTICIPANTS

A purposeful sample of specialists practicing predominantly in a private hospital was

applied. Interviews were conducted until saturation point was reached. In total eleven

interviews were carried out. Descriptive information of the sample is given in Table 3.1.

26

Table 3.1: Characteristics of the participants

Description Range Sample (n=11)

Frequency

Frequency

(Percentage)

Age

20 – 30 0 0.00%

31 – 40 5 45.45%

41 – 50 0 0.00%

51 – 60 6 54.55%

61 + 0 0.00%

Gender Male 9 81.82%

Female 2 18.18%

Total practical years

experience

0 – 10 4 36.36%

11 – 20 1 9.09%

21 – 30 2 18.18%

31 – 40 4 36.36%

Experience within a

private hospital

environment

0 – 10 5 45.45%

11 – 20 0 0.00%

21 – 30 6 54.55%

31 – 40 0 0.00%

Speciality

Ophthalmic surgery 1 9.09%

Gynaecology 2 18.18%

General surgery 2 18.18%

Paediatrics 2 18.18%

Anaesthesiology 2 18.18%

Orthopaedic surgery 1 9.09%

Internal medicine 1 9.09%

The study population consisted mainly of White (100%), male (81.8%) participants

between the ages of 31 to 40 years (45.4%) and 51 and 60 years (54.6%). The

average years in practice in total were 21.4 years whereof 15.3 years were spent in a

private hospital. Specialities included Ophthalmic surgery (1 participant), Gynaecology

(2 participants), General surgery (2 participants), Paediatrics (2 participants),

Anaesthesiology (2 participants), Orthopaedic surgery (1 participant) and Internal

medicine (1 participant).

27

3.3 RESEARCH RESULTS

The interviews started off with two main questions, after which the interviewees were

probed to expand on the answers and responses they presented. These questions

aspired to give a better indication of how specialists define customer centricity and what

their expectations are from private hospitals in terms of customer centricity.

The first question focused on how the participants define and/or conceptualise customer

centricity. The themes that were extracted are indicated in Table 3.2.

Table 3.2: Defining customer centricity

Theme Frequency (n) Percentage

a) Customer focus 16 27.59%

b) Satisfaction 14 24.14%

c) Quality service 10 17.24%

d) Facility and resources 5 8.62%

e) Accessibility 5 8.62%

f) Safety 4 6.90%

g) Cost effective 4 6.90%

a) Customer focus

Customer centricity involves all activities and operations to place the customer at the

centre of a company’s marketing effort with the objective to focus on customers rather

than sales (Dictionary.com, 2013). It is a specific approach in doing business that

focus on the customer (Investopedia, 2013).

Participants indicated that centralising service delivery and resources around the

customer is an important part of customer centricity. Typical responses included: “Die

kliënt is jou primêre verantwoordelikheid”; “Om die kliënt die fokus van die

dienslewering te maak” and “‟n Pasiënt is dan vir daai oomblik my enigste kliënt en my

hele praktyk wentel om basies daai pasiënt”. Results confirmed that 27.59% of the

responses support customer focus.

28

b) Satisfaction

With the change in the complexity of customer expectations it is becoming more difficult

and challenging for organisations to fulfil the expectations of the customer, and still

make a profit (Millstein, 2007:2A; Tyrer, 2009:11). Heskett et al. (1994:164) also

indicated that when customers are satisfied with the services they receive that their

loyalty towards the organisation will increase. Organisations having knowledge of

customers’ needs can provide the right service to the customer at the right time and

place (Womack & Daniel, 2005:61).

Participants also highlighted the following elements of customer satisfaction: focusing

on the satisfaction of the customer, creating a feeling that the customer is an important

asset of the organisation, providing effective services and adequate service outcomes.

24.14% of the responses of participants pointed to satisfaction as an important part of

customer centricity when considering service delivery. Typical responses included:

“Effektiewe diens wat hy mee tevrede is en waavoor hy bereid is om te betaal”; “Die

diens wat jy lewer, moet gelewer word teen „n baie hoë standaard, op „n koste

effektiewe manier, sonder vermorsing van tyd, met pasiënt tevredenheid as einddoel”

and “effektiewe diens wat hy mee tevrede is en waavoor hy bereid is om te betaal”.

c) Quality service

It has been argued that the quality and level of customer service has decreased and

that this can be attributed to a lack of support or understanding at the executive and

middle management levels and/or customer service policy (Dall & Bailine, 2004:61).

Not only does excellent customer service lead to an increase in profits, it also assist

organisations in achieving a competitive advantage (Band, 1988:16; Boshoff & Gray,

2004:27; Carrick, 2010:55; Heskett, Jones, Loveman, Sasser & Schlesinger, 1994:164;

Price, 2012:16). Bourne (2012:64) makes this even more evident by noting that

although the effect of quality and price on customer behaviour is important, the biggest

differentiating factor is friendly, excellent and efficient customer service.

Addressing this theme with the respondents, 17.24% of the responses of participants

acknowledged that quality service delivery has a positive effect on both the customer

and the organisation. They referred to quality service initiatives, a focus on quality

outcomes, the inclusion of cost effectiveness and the providing of a value-for-money

29

proposition as elements of quality service. The participants opined that the provision of

quality services, will ultimately lead to customer satisfaction. Typical responses

included: “Jou diens wat jy moet lewer moet optimaal wees aan jou kliënt”; “Goed

genoeg wees, sy behoeftes bevredig en kostegewys vir hom aanvaarbaar wees” and

“Jou diens wat jy moet lewer moet optimaal wees aan jou kliënt”.

d) Facility and resources

Customer centricity is the alignment of resources of the organisation to effectively

respond to the ever-changing needs of the customer, while building mutually profitable

relationships (Bailey & Jensen, 2006:3).

The provision of facilities and resources (i.e. equipment and human resources) were

some of the elements highlighted as part of the obligation of customer centric

organisations. 8.62% of the responses of participants specified that investment in and

maintenance of facilities and resources lead to an increase in customer centricity.

Typical responses included: “Voldoende dienste daarstel, personeel daarstel” and

“Sentrale plek waar kliënte alles kan ontvang. All in one service”.

e) Accessibility

According to the participants, accessibility includes service availability and the location

of an organisation. Accessibility to services was highlighted in 8.62% of the responses.

Typical responses included: “‟n Instansie wat dit toeganklik maak vir die kliënte, so daar

moet maklike toegang wees...”.

f) Safety

The participants feel that organisations should provide a safe environment for

customers, where they can receive the service they need. Safety is a theme that was

highlighted by participants in 6.90% of the responses. Typical responses included: “Dit

gaan maar suiwer vir my praktyk oor „n veilige plek waar my pasiënte kan afklim” and

“Dit moet veilig wees...vir my pasiënte”.

30

g) Cost effectiveness

Tyrer (2009:15) is op the opinion that an organisation will experience success if it

assists customers in reaching their long term aspirations as opposed to convincing them

to increase their purchases.

Participants believe that if an organisation provides effective services customers will be

persuaded that they received value for their money. In turn, they will be willing to pay a

specific amount for that service. Participants are thus convinced that effective services

which persuade customers that a cost effective deal was delivered, is an important trait

of a customer centric organisation.

6.90% of the responses indicated the necessity for organisations to be cost effective.

Typical responses included: “Ek sou sê dat jy die diens wat jy lewer, lewer teen „n baie

hoë standaard, op „n koste effektiewe manier, sonder vermorsing van tyd met pasiënt

tevredenheid as „n einddoel” and “effektiewe diens wat hy mee tevrede is en waavoor

hy bereid is om te betaal”.

The second question focused on the expectations of doctors with regards to customer

centricity. The themes extracted are indicated in Table 3.3.

Table 3.3: Medical practitioners’ expectations regarding customer centricity

Theme Frequency (n) Percentage

a) Quality patient care and services 103 18.36%

b) Facility and equipment 78 13.90%

c) Effective communication 71 12.66%

d) Support and cooperation 60 10.70%

e) Provision of sufficient and well trained staff 59 10.52%

f) Mutual financial gains 54 9.63%

g) Appreciation 42 7.49%

h) Resolving problems 40 7.13%

i) Involvement in decision making 30 5.35%

j) Respect 24 4.28%

a) Quality patient care and services

The management of private healthcare organisations distinguish them from the public

organisations, because of their knowledge and experience in providing high quality and

31

cost effective healthcare services (CDE, 2011:33). Thus unfortunately, currently the

majority of South African citizens do not have access to high quality healthcare services

(DOH, 2013).

Doctors ranked the provision of quality patient care and services, in the form of nursing

care, customer services and administration assistance, first in their expectancies of

private hospitals. 18.36% of the responses indicated that quality patient care and

services will lead to doctors experiencing an increased customer centricity towards

them. Typical responses include: “As die dienslewering aan die pasiënt op „n

hoogstaande standaard is, met min rompslomp dan is ek tevrede”; “Met my werk gaan

dit suiwer oor pasiëntsorg”; “Die hele ervaring moet goed wees”; “So daar is mediese

sorg, daar is die pasiënt se gemak, sy hele belewenis met die opname proses, die

magtigings en dan die updates op „n gereelde grondslag is baie belangrik vir die pasiënt

en die dokter om dit makliker te maak”; “Primêr, sal ek sê dat my geluk hang af van hoe

die pasiënte gehanteer word” and “Die prioriteit is altyd goeie mediese diens”.

b) Facility and equipment

The private healthcare industry in South Africa has grown dramatically with the doubling

of the number of beds between 1988 and 1993. This growth is a direct result of

international trends toward privatisation and advanced by privatisation policies of

government. This resulted in the migration of doctors from public service to private

practices (Coovadia et al., 2009:826). Customer centricity refers to the alignment of an

organisation's resources to effectively respond to the ever-changing needs of the

customer and at the same time to build mutually profitable relationships (Bailey &

Jensen, 2006:3). For the purpose of this study, it is therefore imperative that doctors

should be equipped with the necessary resources to perform their duties successfully

(Edwards et al., 2002:837).

In the contexts of this study, participants included the following in their responses

pertaining to facilities and equipment, which have an impact on them as the hospital's

customer: buildings, relevant ward and theatre equipment and consulting rooms. The

provision of appropriate and sufficient facilities and resources, as an element of

customer centricity towards doctors, was highlighted in 13.90% of the responses.

Typical responses included: “Daar moet „n fasiliteit wees vir my om te werk, daar moet

32

beddens wees vir my pasiënte, daar moet teatertyd wees”; “Daar moet in die teater die

beste beskikbare toerusting wees” and “Dat „n ou die nodige fasiliteit het, personeel het,

nodige apparaat het om „n mens se werk te kan doen”.

c) Effective communication

Organisations have to truly understand who their customers are and what their needs

are. Information of customers should be gathered by means of customer surveys,

interviews with customers and observation of customers’ behaviour where customer

involvement plays a vital role (Bailey & Jensen, 2006:6). Organisations, having this

knowledge, can provide the right service to the customer at the right time and place

(Womack & Daniel, 2005:61). Gummesson (2008a:323) opined that organisations and

people are brought together through the establishment and upholding of relationships.

Organisations should therefore interact with customers in these relationships and not

merely manage the relationship with the customer. A balanced customer centricity

should therefore be achieved with mutually beneficial relationships with all stakeholders

inclusive of customers.

Participants were of the opinion that important elements of customer centricity include to

communicate any/all decisions that have been made in/for the hospital, to implement

communication methods and to apply honest communication. A total of 12.66% of the

responses emphasised the necessity of effective communication as a prerequisite for

customer centricity. Typical responses included: “Die ideaal is eintlik as daar meer

kontak kan wees tussen die besluitnemers, en die soldate op die grond wat maar eintlik

die werk doen en wat die effekte dra van dikwels die besluite wat geneem word en wat

nie altyd die agtergrond van die besluit verstaan nie” and “Daar kan miskien bietjie

beter, vriendeliker kommunikasie wees en gedebatteer word”.

d) Support and cooperation

JL Watson Consulting (2012) identified that a customer centric focus, in its simplest and

most pure sense, means to make the customer's life easy. It involves designing

processes that are focused on delivering a positive experience to the customer. This

would involve providing an effortless way for the customer to learn about the

organisation, do business with the organisation and get support from the organisation

when it is needed. Mutual support and respect are fundamentals in ensuring a

33

successful relationship between doctors and healthcare providers (Edwards et al.,

2002:837).

Doctors want to experience a sense that private hospitals protect their interests on

multiple levels. Some participants also expressed a need for partnering with private

hospitals within interdependent relationships. Support and cooperation were highlighted

in 10.70% of the responses. Typical responses included: “Ons het die hospitaal nodig

en die hospitaal het ons ook nodig, dit is „n sinergisme”; “Die hospitaal moet my

bystaan” and “Dit is vir my belangrik dat mens nie in isolasie werk nie”.

e) Provision of sufficient and well trained staff

Doctors are attracted to hospitals because of modern facilities, new technology,

considerate and supportive management and quality of care through nursing staff.

Well trained and sufficient nursing staff formed the primary element for this theme. Also

included were all support services such as administration, pharmacy services,

marketing and technical staff. 10.52% of the responses of participants confirmed that

providing sufficient well trained staff would lead to an increased customer centric

experience. Typical responses included: “Genoeg personeel in die eerste plek, en in

die tweede plek opgeleide personeel”; “Dit skep nie „n lekker indruk as „n gevoel

bestaan dat die verpleegpersoneel nie lekker seker is wat aangaan nie” and “„n

Personeelkorps wat die uitdaging van moderne medisyne verstaan en wat op pasiënt

dienslewering gefokus is”.

f) Mutual financial gains

Customer centricity is the alignment of resources of the organisation to effectively

respond to the ever-changing needs of the customer, while building mutually profitable

relationships (Bailey & Jensen, 2006:3). Healthcare providers attempt to align with

doctors for various strategic reasons such as increase in revenue, enhancement of

quality healthcare services, cost control and effective managed care (Burns, et al.,

2001:10).

This theme includes contract negotiations with medical aids, profit for all parties in

services that are provided and the distribution of shares. The participants also

34

confirmed that a hospital's delivery of quality service to patients will have a direct impact

on the number of patients they admit in a specific hospital. Mutual financial gains are

highlighted as an element of customer centricity in 9.63% of the responses. Typical

responses encompassed: “‟n Privaat hospitaal is in die bedryf om een rede, en dit is

geldmaak. Ek is ook in die bedryf om geld te maak en iewerste moet ons mekaar langs

die pad net ontmoet” and “Ek glo dat aandele wat aan dokters verkoop word „n goeie

ding is”.

g) Appreciation

The participants remarked that doctors should be appreciated as income generators

and customers of the hospital. They would like to be acknowledged as important role

players within a hospital. 7.49% of the responses showed that appreciation for the work

doctors do is an expectation of customer centricity. Typical responses were: “Regtig

moeite doen om die dokters te laat voel hulle is „n belangrike deel van die span en dat jy

nie voel die hospitaal kan sonder jou klaarkom nie” and “Baie keer word dokters hanteer

asof hulle „n werknemer is en in diens van die instansie is”.

h) Resolving problems

Results proved that frustration and dissatisfaction are caused when private hospitals do

not attentively listen to doctors and do not resolve the problems they may have, as

highlighted in some of the responses. Participants also highlighted that they need to get

feedback on problems that were communicated and addressed. 7.13% of the

responses indicated that the participants would feel that private hospitals are more

customer centric if the problems they experience are resolved. Typical responses

comprised: “As probleme glad nie aangespreek word nie, dan sal mens uit die aard van

die saak ongelukkig wees. As jy voel die bestuur en so aan kry nie die probleem

opgelos nie dan gaan dit mens frustreer” and “Wat ek gewoonlik waardeer is as

probleme vinnig uitgesorteer word en ek vinnig terugvoer kry”.

i) Involvement in decision making

Participants mentioned that when decisions, such as the procurement of equipment

and availability of certain medication, directly affect doctors they would like to provide

private hospitals with inputs before final decisions are made. Involvement in decision

making was highlighted as an expectation of customer centricity in 5.35% of the

35

responses. Typical responses included: “Dokters moet insette hê as daar personeel

aangestel word”.

j) Respect

The participants indicated that doctors would like to be respected as independent

practitioners and they should be respected for the value they add to hospitals,

irrespective of their speciality. Mutual support and respect are prerequisites for

ensuring a successful relationship between doctors and healthcare providers (Edwards

et al., 2002:837). In accordance with the literature, 4.28% of the responses highlighted

that respect is certainly an expectation of customer centricity. One of the responses

that confirms this viewpoint was: “Daar moet wedersydse respek wees”.

3.4 CHAPTER SUMMARY

A simplistic definition of customer centricity is placing the customer at the centre of a

company’s marketing effort, focusing on customers rather than sales (Dictionary.com,

2013). It is a specific approach to do business by focusing on the customer

(Investopedia, 2013).

Customer centricity also involves designing processes that are focused on delivering a

positive experience to the customer, making it extremely easy for the customer to learn

about the organisation, do business with the organisation and get support from the

organisation when it is needed (Investopedia, 2013). A customer focused organisation,

focus on the factors which improves the experience and the life of customers (JL

Watson Consulting, 2012). Participants mainly defined customer centricity as being a

focus on the customer (27.59%).

Realising profit, whilst meeting the expectations of customers is posing a greater

challenge for organisations than before. This is because of customer expectations

becoming more complex (Millstein, 2007:2A; Tyrer, 2009:11). However, organisations

that place their focus on determining and meeting the expectations of customers will be

able to provide the right service at the right time and place to customers (Womack &

Daniel, 2005:61). Customer loyalty is a reward for organisations that succeed in

obtaining customer satisfaction (Heskett et al., 1994:164). Participants indicated that

36

focusing on customer satisfaction (24.14%), is an important element of customer

centricity.

The delivery of quality services holds certain advantages, including an increase in

profits and a competitive advantage (Band, 1988:16; Boshoff & Gray, 2004:27; Carrick,

2010:55; Heskett, Jones, Loveman, Sasser & Schlesinger, 1994:164; Price, 2012:16).

Bourne (2012:64) makes this even more evident by noting that although the effect of

quality and price on customer behaviour is important, the major differentiating factor is

friendly, excellent and efficient customer service. Participants (17.24%) acknowledged

that high quality service is of great importance and also has numerous advantages for

both the customer and the organisation.

Participants noted that their expectations pertaining to customer centricity include the

provision of quality care and services to their respective patients (18.36%). They

opined that an increase in patient satisfaction with regards to the service and care

provided to them would result in an increased feeling of customer centricity on the part

of the medical practitioner.

Participants (13.90%) highlighted another expectation, namely that private hospitals

should ensure that appropriate facilities and resources are available to enable doctors

to deliver the needed healthcare services. Participants focused on the provision of safe

and accessible facilities where the necessary resources and equipment are made

available. This will enable them to provide medical care to their patients. It was further

indicated that effective communication (12.66%), inclusive of truthful and effective

communication methods and the involvement in and communication of operational

decisions, will result in a higher sense of customer centricity.

Chapter 4 follows with a discussion of the conclusions, recommendations and

limitations of the study.

37

CHAPTER 4: CONCLUSIONS, LIMITATIONS AND

RECOMMENDATIONS

The purpose of this chapter is to provide conclusions regarding the results obtained in

the empirical study of this research. Conclusions are drawn with regards to the

research objectives. Furthermore, limitations that have been identified throughout the

course of the study are discussed. Finally, recommendations for private hospitals are

made and research opportunities that emanate from this research are presented for

future research.

4.1 CONCLUSIONS

The general objective of this research was to determine medical practitioners’,

associated with a private hospital, understanding and expectations of customer

centricity. The following conclusions can be drawn, based on questions posed in the

research.

The first objective was to determine how customer centricity is conceptualised in the

literature. A simplistic definition of customer centricity is placing the customer at the

centre of a company’s marketing effort, focusing on customers rather than sales

(Dictionary.com, 2013). It is a specific approach to do business that focus on the

customer (Investopedia, 2013).

Organisations focused on customer centricity ensure that the customer is at the centre

of an organisation’s philosophy, operations or ideas and they operate from the belief

that their clients are the only reason they exist. These organisations will use every

mean possible to keep the client/customer happy and satisfied (Investopedia, 2013). JL

Watson Consulting (2012) indicated that a customer centric focus, in its simplest and

most pure sense, means making the customer's life easy. It involves designing

processes that are focused on delivering a positive experience to the customer; making

it extremely easy for the customer to learn about the organisation, do business with the

organisation and get support from the organisation when it is needed. Customer

centricity is also the alignment of an organisation's resources to effectively respond to

38

the ever-changing needs of the customer and at the same time build mutually profitable

relationships (Bailey & Jensen, 2006:3).

The second objective was to determine the differences and similarities between

customer services and customer centricity, as described in literature. Customer service

is the provision of services to customers before, during and after a purchase. It is a

series of activities designed to enhance the level of customer satisfaction, i.e. the

feeling that a product or service has met the customer expectation (Boshoff & Gray,

2004:27; Turban, Lee, King, Liang & Turban, 2009:61).

Whilst customer centric organisations explore ways to satisfy the needs of their

customers with delivering greater value, making it easier and a more delightful

experience, customer focused organisations only fulfil customer needs in so far as they

are self-serving and address the organisation’s imperatives (Finkelstein, 2013). The

main difference between customer service and customer centricity appears to relate to

meaningful changes that customer centric organisations make in addressing their

customers’ expectations and providing reciprocal support. Customer centricity seems to

take customer service thus a step further with regards to service delivery.

The third objective was to determine how customer centricity is defined by medical

practitioners associated with a private hospital. Customer centricity was defined by the

participants as comprising a focus on the customer (27.59%), where service delivery

and resources are centralised around the customer whilst focusing on the customer as

an important asset of the organisation. They also noted that aligned with customer

centricity is the satisfaction with the provision of effective services and satisfactory

service outcomes (24.14%). Participants (17.24%) further indicated that customer

centricity is the positive effect of providing quality service for both the customer and the

organisation. Also, the quality service initiatives should focus on quality outcomes

inclusive of cost effectiveness and a value-for-money proposition. 6.90% of the

responses indicated that the provision of effective services should result in a feeling of

value for money and for which customers are willing to pay. Participants also

conceptualised customer centricity as the provision of resources and facilities (8.62%)

that is accessible to patients (8.62%), and that is safe (6.90%).

39

The fourth objective was to determine the expectations of medical practitioners,

associated with a private hospital, in terms of customer centricity from the hospital. The

study results proof that quality patient care and services (clinical and non-clinical) will

lead to an increased feeling of customer centricity with doctors (18.36%) along with the

provision of appropriate and sufficient facilities and resources (13.90%), which include

safe and accessible facilities and appropriate equipment and resources. Participants

indicated that effective communication (12.66%) is an important expectation of

experiencing customer centricity. They further noted receiving support and cooperation

from the hospital (10.70%); having well trained staff members (10.52%), with specific

focus on nursing personnel, and experiencing mutual financial gains (9.63%) in the form

of medical aid negotiations and shareholding, will increase their perception of customer

centricity. Doctors would also like to be appreciated (7.49%) for the value they add to

the private hospital industry, feeling that they are respected (4.28%) and have their

problems resolved as they arise (7.13%). Participants further indicated involvement in

decision making (5.35%), with regards to operational matters that directly concern them

and the appointment of employees as an expectation of a customer centric hospital.

4.2 LIMITATIONS

Due to the busy schedules of specialists, finding an appropriate time for interviews

posed a challenge. Some of the interviews had to be rescheduled due to unforeseen

circumstances. For specialists, time is literally money.

As the researcher is an employee of a private hospital, some of the participants used

the interviews as an opportunity to raise operational issues. The participants had to be

reminded that the study is referring to private hospitals in general and not only issues

that can be addressed by the researcher.

Little research was done in the past, specifically with regard to a customer centric

approach toward doctors as customers in the private hospital industry. Thus, limited

literature on this topic is available.

Doctors involved with a private hospital over a longer term, expressed more negative

aspects. This was mainly due to negative experiences in the past.

40

Lastly, all respondents were Afrikaans, and English terminology posed a challenge in

some of the interviews. The responses were not translated to English, but were quoted

in Afrikaans. This was to ensure that the essence of the responses was not lost in

translation. Some specialists are only focused on clinical matters and operational

issues and terminology, specifically those aspects addressed in the study, were

experienced as unfamiliar territory to some of the participants.

4.3 RECOMMENDATIONS

The fourth objective of this study was to make recommendations for future research.

This section therefore suggests recommendations for management members in the

private hospital industry and recommendations for future research.

4.3.1 Recommendations for management members in the private hospital

industry

A vast majority of the participants indicated that should quality care be provided to their

patients (private hospitals placing their patients at the centre of operations and care), it

will lead to an increased feeling of customer centricity within themselves.

Some of the participants indicated scepticism towards the customer service, customer

centricity and partnering efforts of private hospitals or private hospital groups. They

have indicated that they are not convinced that their welfare will be protected by these

private hospitals or private hospital groups and that these efforts are merely tactics to

enhance the interest of these private hospitals or private hospital groups. Therefore it is

recommended that the organisation should investigate tactics that are necessary to

recover and establish trust relationships with health practitioners.

Shah et al. (2006:113) noted that organisations which are truly customer centric can

experience a 30% higher return on investment (ROI) on marketing efforts than their

peers not embracing customer centricity. Customer centricity is becoming imperative

for the gaining of a competitive advantage in a crowded marketplace (Evans, 2008:22).

The organisation should thus focus on customer centricity as a tool for the realisation of

financial advantages.

41

4.3.2 Recommendations for future research

The view of customer centricity by specialists and the elements that create a feeling of a

private hospital placing the doctor at the centre of its operations need to enjoy further

research.

The study can be enlarged to include general practitioners who refer patients to

specialists. Their stance on the topic can serve as valuable inputs. Quantitative

research on specific elements of customer research can be conducted. The study can

also be done qualitatively and/or quantitatively (or in combination of approaches) at

other private hospitals, managed by different hospital groups and other geographical

areas. This will provide data for comparative analysis.

Some of the participants indicated their need for partnering more with private hospitals

in providing quality clinical care. Future research on the establishment of partnerships

between doctors and private hospitals, and not merely treating the doctor as a customer

of private hospitals, can be considered.

Some of the participants indicated scepticism towards the customer service, customer

centricity and partnering efforts of private hospitals or private hospital groups. They

have indicated that they are not convinced that their welfare will be protected by these

private hospitals or private hospital groups and that these efforts are merely tactics to

enhance the interest of these private hospitals or private hospital groups. Future

research is recommended to determine the elements that lead to an increased feeling of

trust between doctors and private hospitals.

42

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